Nicotine content the major health concern

A 30-year tobacco habit has etched lines in his face, given his skin an associated pallor.

Months ago, Cheyenne Church switched to vaping, using an atomizer that allows him to inhale nicotine at a concentration of 18 milligrams and exhale water vapor. It provides the buzz of smoking without the tar, smell and other harmful chemicals in tobacco, he said. He particularly likes the flavor combination of menthol and chocolate, a Peppermint Patty.

As manager at the kiosk Brilliant Smoke in Patrick Henry Mall in Newport News, part of a national chain for e-cigarette vaping systems, Church pointed to the "step-down" program in which the amount of nicotine is gradually reduced to zero to help wean people from the habit.

"Nicotine is as addictive as cocaine," he said as he supplied a five-year customer with 12-milligram liquid nicotine. "It's difficult to get people to stop."

Mothers bring their sons and doctors send patients who want to quit smoking, he said, though studies don't yet support their widely held claim as a smoking cessation tool.

The e-cigarette business is booming, touted as "a healthier alternative" to smoking by manufacturers and advocates alike.

Still, almost nothing is known about the health effects of their use. Further, there's concern that the use of flavors with catchy names, such as Daydream Cream, Pixie Dust and Cherry Limeade, acts as a lure to youth, drawing them into experimentation and nicotine dependence.

"In truth, we really don't know the implications of nicotine used in this form," said Kirk Cumpston, medical director of the Virginia Poison Center in Richmond. He characterized nicotine, once used as an extremely effective insecticide, as "one of the most addicting substances out there."

The Virginia General Assembly passed a law earlier this year that makes it illegal for minors to buy or possess e-cigarettes. It takes effect July 1. The U.S. Food and Drug Administration is considering regulations for e-cigarettes now.

How they're sold

E-cigarettes come in several forms and range in price from a few dollars for disposables — "equivalent to a pack and a half of traditional cigarettes," according to the literature from Blu, a leading e-cigarette company — to hundreds of dollars for vapor systems with rechargeable lithium batteries, USB chargers and a variety of flavored liquids that consumers can mix and match to their taste.

The disposables make up the bulk of the market –– both Altria and Reynolds American are launching their own brands this summer — and are available at convenience stores and many places where tobacco products are sold. The more elaborate systems are sold online and at specialty "vaping" stores like Brilliant Smoke, Hampton Pipe & Tobacco and Just Breathe on the Peninsula.

After the start-up costs of buying a system, it's significantly cheaper to "vape" than to smoke tobacco.

"It was costing me 12 bucks a day and now I'm spending $12 a week," said James Wilkinson, a two-pack-a-day smoker who switched to vaping in January. He started with a 3-milligram nicotine disposable before moving on to the reusables after a month, he said as he dripped a papaya/plum nicotine-free liquid into his vaporizing system at the counter at Just Breathe in Hampton. The change is also saving him time. It used to take him seven minutes to smoke a cigarette, he said, but now in just two minutes he achieves his "smoke reach."

Instead of smoking nonstop, he uses his e-cigarette about four or five times a day and nicotine-free he no longer feels sluggish and tired, he said.

Just Breathe proprietor Bryan Enriquez, a DJ who has opened a chain of vaping stores since November, used to be a heavy hookah smoker, but has switched to high-nicotine e-cigarettes — 24 milligram –– which he considers a healthier alternative. "What's in the fluids is all manufactured in FDA-approved labs," he said, sweeping his arm across shelves of flavors, including eight versions of peach alone.

That's a common claim about liquids that are U.S.-made, but there's no basis for it, according to the agency. "We don't know what that means," said Jennifer Haliski, an FDA spokeswoman. "We don't currently regulate any flavors or e-cigarette products. We do not have jurisdiction over them."

Vapor systems also come in various sizes and degrees of complexity. One bottle of fluid allows the equivalent smoking time of five cartons of cigarettes, or 50 packs, said Church. The larger the system, he said, the more vapor and taste, as well as the opportunity to mix fluids together. "It's whatever you want to mix in. A girl here mixed up a Skittles concoction," he said.

For first-time users, store personnel typically assess customers' current nicotine intake and start them at a slightly lower level in e-cigarettes.